Gout

Introduction

Gout is a type of arthritis that occurs when too much uric acid builds up in the body, causing crystals to form in joints, and joints to become inflamed and painful. It can be hereditary or result from another condition. Gout usually affects men over 40 with a family history of gout, but it can occur at any time, and also affects women, especially after menopause. Excessive intake of food and alcohol, surgery, infection, physical or emotional stress, or the use of certain drugs can lead to the development of gout.

Signs and Symptoms

Extreme pain in a single joint, usually the base of the big toe; it can also affect other joints (such as the feet, fingers, wrists, elbows, knees, or ankles).

Joint is shiny red or purple, swollen, hot, and stiff.

Fever as high as 39 °C (102.2 °F), with or without chills.

Symptoms can develop very quickly, with the first episode often occurring at night, then go away after 5 to 10 days only to come back later.

In later attacks, you may see lumps (called tophi) just under the skin in the outer ear, hands, feet, elbow, or knee.

What Causes It?

The body produces too much uric acid, doesn't excrete enough uric acid, or both. The acid accumulates in tissues in the form of needle-like crystals that cause pain. Uric acid is formed when the body digests purines, compounds found in some foods and beverages, including dried beans, liver, wine, and beer. Gout generally occurs because of a predisposition to the condition, but it can result from blood disorders or cancers, such as leukemia, or the use of certain drugs. Risk factors include:

Family history of gout

High levels of triglycerides

Drinking too much alcohol

Eating foods rich in purines, such as meat, shellfish, and sweetbreads.

Surgery

Metabolic syndrome

What to Expect at Your Doctor's Office

Your doctor will examine the affected joint, evaluate your pain, and may ask if there is any history of gout in your family. Your doctor may take a sample of fluid from the affected joint, draw blood for a blood test, or take x-rays to rule out other possibilities.

Treatment Options

Your doctor may give you ibuprofen or another nonsteroidal anti-inflammatory drug (NSAID) to reduce pain and swelling. You must avoid alcohol and foods that trigger your attacks. Besides NSAIDs, you may receive other drugs. Colchicine can help treat an acute attack and prevent future attacks but has serious side effects. Corticosteroids, corticotropin, and intra-articular corticosteroids are also used, particularly in patients who have contraindications to NSAIDs and colchicine. The Food and Drug Administration (FDA) has approved other medications to treat gout, including allopurinol (Zyloprim), febuxostat (Ulonic), and pegloticase (Krystexxa). Most rheumatologists use combination therapy to treat acute gout. In a patient without complications, NSAIDs are the preferred therapy. These drugs help control gout but do not cure it.

Complementary and Alternative Therapies

A combination of therapies can be very effective at decreasing both the length and frequency of attacks. When choosing complementary and alternative therapies for gout treatment, it is best to work with a knowledgeable provider. Herbs and supplements that may be beneficial for some people, may be harmful for others. If you are pregnant, or thinking about becoming pregnant, do not use any CAM therapies unless directed to do so by your physician.

Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers). Some nutrition-minded doctors promote a low fructose diet to treat gout. Another theory states that one half pound of cherries per day (fresh or frozen) for 2 weeks lowers uric acid and prevents attacks. Cherry juice (8 to 16 oz. per day) is also helpful.

Eat more high fiber foods, including oats, root vegetables (such as potatoes and yams), and psyllium seed.

Avoid refined foods, such as white breads, pastas, and sugar.

Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.

Drink 6 to 8 glasses of filtered water daily to help flush uric acid from the body. Dehydration often triggers a gout attack.

Exercise at least 30 minutes daily, 5 days a week.

Avoid sugar sweetened soft drinks. Diet soft drinks have not been associated with the risk of gout.

You may address nutritional deficiencies with the following supplements:

A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc and selenium.

Omega-3 fatty acids, such as fish oil, 1 to 2 capsules or 1 tablespoons of oil daily, to help decrease inflammation and promote general health. Cold-water fish, such as salmon or halibut, are good sources. Talk to your health care provider before taking omega-3 supplements if you are taking blood-thinning medications, such as aspirin or warfarin (Coumadin).

IP-6 (inositol hexophosphonate), check with your alternative health care provider for proper dosing. Caution: May increase the blood-thinning effects of anti-clotting medications, such as warfarin (Coumadin) and others. IP-6 may lower iron and calcium in the body.

N-acetyl cysteine, 200 mg daily, for antioxidant effects.

Vitamin C, 500 to 1,000 mg daily, as an antioxidant. In one study, higher vitamin C intake was independently associated with a lower risk of gout.

Avoid taking extra niacin and vitamin A. Both may play a role in gout.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone, or in combination, as noted.

Cranberry (Vaccinium macrocarpon), for kidney health. You may also take 8 to 16 ounces of unsweetened cranberry juice daily.

Green tea (Camelia sinensis), for antioxidant and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.

Devil's claw (Harpagophytum procumbens), for pain and inflammation. Devil's claw may increase the blood-thinning effect of certain medications, such as aspirin and warfarin (Coumadin). Devil's claw should never be used during pregnancy, or while breastfeeding. It can potentially affect blood sugar levels, as well as blood pressure, and can interact with many medications.

Cat's claw (Uncaria tomentosa) standardized extract, 20 mg, 3 times a day, for inflammation, immune, and antibacterial/antifungal activity. Cat's claw may worsen certain conditions, such as leukemia or some autoimmune disorders. Cat's claw may also interact with many different medications. Talk to your doctor.

Bromelain (Ananus comosus), for pain and inflammation. Bromelain can increase the blood-thinning effect of certain medications, such as aspirin and warfarin (Coumadin).

Turmeric (Curcuma longa), for inflammation. Tumeric may increase the blood-thinning effect of certain medications, such as aspirin and warfarin (Coumadin).

Acupuncture

Acupuncture may help manage pain associated with gout.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of gout symptoms (such as pain and inflammation) based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account your constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for you individually.

Some of the most common remedies used for gout are listed below. A common dose is 3 to 5 pellets of a 12X - 30C remedy every 1 to 4 hours until your symptoms improve.

Aconite for sudden onset of burning pain, anxiety, restlessness, and attacks that come after a shock or injury. Also take if your joints are swollen and painful.

Belladonna for intense pain that may be throbbing, if motion worsens pain and pressure improves it, or if the joint is very hot.

Berberis vulgaris for spasms of pain in joints or twinges made worse by walking. There may be back pain and a tendency to develop kidney stones.

Bryonia for pain that worsens with motion, or if pain is better with pressure and with heat.

Colchicum for pains made worse by motion and weather changes, especially if there is any nausea associated with the attacks.

Ledum when joints become mottled, purple, and swollen, or if the pain is much better with cold applications and is worse when overheated.

Rhus toxicodendron for stiff, swollen joints that are hot and painful, or if the pain is worse with cold applications and better with heat.

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